Caesarean section

Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

What is a Caesarean section?
Even though a vaginal delivery is the most common way to give birth, a Caesarean section is often advised and performed in certain situations.

The relative safety of Caesarean sections has seen a rise in the number of women being delivered in this way. Most maternity units in the UK deliver between 10 and 20 per cent of babies by Caesarean section.

A Caesarean may be planned in advance (elective section) or be performed at short notice, particularly if there are complications or difficulty in labour (emergency section).

An elective Caesarean section is performed one to two weeks before the baby's due date. This ensures the baby is mature before delivery.

When is a Caesarean necessary?
In some situations a Caesarean may be the only safe option for mother and baby, for example when:

• the placenta lies so low in the uterus that it covers the exit to the birth canal (cervix). This is called placenta praevia.
• the obstetrician finds out that baby's health is threatened due to lack of oxygen.
• there is vaginal bleeding and a natural delivery is not about to happen.
• the umbilical cord falls forwards and the baby cannot be delivered easily (a condition known as cord prolapse).
• it becomes clear during labour that the mother will be unable to deliver the baby herself.

In other situations a Caesarean may be considered the safest option even though a vaginal birth is a possibility:

• if the baby is lying with its head upwards (breech baby).
• if the mother is affected by high blood pressure or other illness.
• if the unborn baby is too small or too weak to survive a natural birth.
• if the mother has had a Caesarean birth before (although it is possible for a mother who's had a Caesarean to have a vaginal delivery in a later pregnancy).
• in very rare cases, when the mother is so anxious about the delivery that a Caesarean is considered.

If you wish to have a Caesarean section without a medical reason, you should discuss this with your obstetrician. You don't have an automatic right to demand a Caesarean if it's considered not to be in your best interests medically.

What happens during a Caesarean?
At a Caesarean section there will be the surgeon (obstetrician) and his or her assistant, the anaesthetist and assistant, the scrub-nurse, two other nurses or midwives and a paediatrician.

Your partner can be present if the operation is being carried out under a spinal or epidural anaesthetic.

An incision of about 20cm is made across the lower abdomen. The baby is delivered through the skin after the womb is opened. The womb is easily opened and it takes only a few minutes for the baby to be born.

After the placenta (afterbirth) is delivered, the obstetrician closes the incision. Dissolving stitches or staples are used to close the skin.

From beginning to end, an uncomplicated Caesarean will take between 20 and 30 minutes.

What will I feel during the Caesarean?
Most anaesthetists will perform a spinal or epidural anaesthetic via a fine needle placed midway down the spine.

You will experience some feeling of pressure during the Caesarean, but will not feel pain.

A general anaesthetic may be advised under certain circumstances. This is when you are rendered temporarily unconscious.

What are the risks?
A Caesarean section is a safe operation for you and your baby. However, as with any major surgery, there are risks involved.

The main risks are for the mother, such as heavy bleeding at the time of surgery and after delivery, infection in the wound or the development of a blood clot (thrombosis) in the leg veins.

Your obstetrician and midwife will ensure that the appropriate measures are taken to reduce your risk of developing of complications.

What about after the Caesarean?
Most women are up and about within 24 hours of a Caesarean. Pain from the wound is controlled with appropriate painkillers. Most mothers leave hospital four or five days after a Caesarean birth.

A Caesarean section should not prevent a mother from breastfeeding her baby.

Future pregnancies may also need to be delivered by Caesarean section because some indications for the original Caesarean persist into subsequent pregnancies.

However, the majority of women will be able to have a vaginal birth next time.

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